- Glargine (Lantus) doses >0.5 IU/kg/day in patients with type 2 diabetes (T2D) do not improve glycemic control but may promote weight gain.
- Instead, consider treatment intensification with prandial insulin or other type of glucose-lowering agent.
Why this matters
- Basal insulins do not improve postprandial glucose levels, which typically worsen as T2D progresses.
- Pooled data from 3 prospective, randomized, controlled trials of ≥24 weeks in 458 patients with T2D uncontrolled on metformin, sulfonylurea, and insulin glargine U100.
- Funding: Sanofi US, Inc.
- From baseline fasting plasma glucose (FPG) 200 mg/dL, greatest reduction (~40 mg/dL per 0.1 IU/kg/day increase in insulin dose) in FPG with insulin doses ≤0.3 IU/kg/day.
- Smaller FPG reductions at higher insulin doses, plateauing at ~15 mg/dL per 0.1 IU/kg dose increase at doses >0.5 IU/kg/day.
- From mean baseline HbA1c 8.7%, greatest effect was 0.5 IU/kg/day, plateauing at ~0.3% for each 0.1 IU/kg/day increase.
- Hypoglycemia incidence similar across insulin doses.
- Mean weight increase of 1.4 kg seen with final insulin dose >0.5 IU/kg/day.
- Post hoc analysis, pooled data.
- Requirement for both metformin and sulfonylurea use.
- Small cohort samples.